Wiki Genetic Cancer Testing

[companey]

I have a quick question since I am new to Laboratory billing and coding. Our billing company test for Genetic Cancer and we receive a requisition from the doctor which states what test are being ordered. We are only receiving Authorization from the Insurance company on 1 CPT code (81211-BRCA1/BRCA2) out of 24 CPT codes that are on the order. The main questions is are we obligated to bill all CPT codes or can we bill just what we received authorization for from the Insurance company??? Some of the Insurance companies deny the whole claim and say we are testing a panel, but we do have authorization for 1 of the CPT codes. Is there documentation for the answer for I can review and share with my colleagues. Any information would be gratefully appreciated!!

 

[simam]

The best thing to do is to contact insurance company provider service line and post the same question. A good payer rep should ask u all cpt codes and check for you to see if pre auth needed or not. Some CPT codes don't need auth depending on policy and insurance .